Evaluating the Safety and Efficacy of Same Calendar Day Discharges for Total Joint Arthroplasty in a Veterans Affairs Hospital.

Abstract

Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures performed in the United States. In the Veterans Affairs (VA) health care system, there has been a slower adoption of the early discharge models due to medical and social complexities of patients. Our study aimed to determine the outcomes of a same day discharge protocol. Patients discharged on the same calendar day of surgery were compared to patients discharged on postoperative day one or later. Retrospective review of all patients undergoing primary TJA over a 3-year period (January 1, 2020, to December 31, 2022) was performed. Patients were split into two cohorts: same calendar day discharge (SDD) versus next calendar day or greater (EDJ) discharge. Cohorts were subdivided into hip and knee arthroplasty. Patient demographics, medical comorbidities, length of stay, 30-and 90-day complications, 90-day readmissions, and emergency room (ER) visits were assessed. There were 233 EDJ cases compared to 143 SDD cases. The SDD had more males; otherwise, no significant differences in demographic data existed. The mean length of stay in the EDJ group was 1.2 days (range, one to four). Overall, 30-day (5.6% EDJ versus 3.5% SDD) and 90-day complications (3.9% EDJ versus 4.2% SDD), readmissions (3.4% EDJ versus 2.8% SDD), and ER visits (9.0% EDJ versus 9.1% SDD) were similar between cohorts. Subanalysis of the THA and TKA similarly demonstrated no statistically significant results. Our study showed when comparing SDD to next calendar day or greater discharges at a VA health system, there was no difference in outcomes or complication rates. Discharging patients on the SDD does not increase ER visits. We have shown the feasibility and effectiveness of an SDD program in a VA health care system. Future studies will focus on longer-term outcomes and patient satisfaction after SDD from a VA medical center.